Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment

Dural AVFs located in the posterior fossa are a rare entity. The objectives of the study were to analyze the anatomy of dural AVFs, their endovascular treatment strategies, and clinical outcomes. Two centers retrospectively selected patients treated between January 2009 and June 2018 having posterio...

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Bibliographic Details
Published in:American journal of neuroradiology : AJNR 2019-08, Vol.40 (8), p.1363-1368
Main Authors: Détraz, L, Orlov, K, Berestov, V, Borodetsky, V, Rouchaud, A, de Abreu Mattos, L G, Mounayer, C
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Central Nervous System Vascular Malformations - pathology
Central Nervous System Vascular Malformations - therapy
Embolization, Therapeutic - methods
Endovascular Procedures - methods
Fellows' Journal Club
Female
Humans
Interventional
Life Sciences
Male
Middle Aged
Neurons and Cognition
Neurosurgical Procedures - methods
Retrospective Studies
Subarachnoid Space
Treatment Outcome
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Summary:Dural AVFs located in the posterior fossa are a rare entity. The objectives of the study were to analyze the anatomy of dural AVFs, their endovascular treatment strategies, and clinical outcomes. Two centers retrospectively selected patients treated between January 2009 and June 2018 having posterior fossa dural AVFs. We collected patient demographics, clinical presentation, arterial and venous outflow anatomy of the dural AVFs, and treatment outcomes. Twenty-six patients treated endovascularly for posterior fossa dural AVFs, type III, IV, or V, were included. One hundred percent of the dural AVFs were occluded. A transarterial approach was performed in 23 dural AVFs (88.5%); a combined transarterial and transvenous approach, for 2 dural AVFs (7.7%); and a transvenous approach alone, for 1 dural AVF (3.8%). The middle meningeal artery was the most common artery chosen to inject embolic liquid (46%, 12/26). Procedure-related morbidity was 15.4% at 24 hours, 7.7% at discharge, and 0% at 6 months. Procedure-related mortality was 0%. Endovascular treatment offers high occlusion rates for posterior fossa dural AVFs with low morbidity and mortality rates. The arterial approach is the first-line preferred approach, even if a transvenous or combined approach would be a safe and effective option for patients with favorable anatomy.
ISSN:0195-6108
1936-959X
DOI:10.3174/ajnr.A6140